Organization
AVANTI REHAB GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE EVANGELISTA M.D. (OWNER)
(248) 626-2416
Entity
Organization
Contact information
Practice address
6079 W MAPLE RD, SUITE 110-B, WEST BLOOMFIELD, MI 48322-2283
(248) 626-2416
(248) 626-3918
Mailing address
6079 W MAPLE RD, SUITE 110-B, WEST BLOOMFIELD, MI 48322-2283
(248) 626-2416
(248) 626-3918
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
09/29/2010
Last updated
12/14/2010
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